P02-11 Effectiveness and implementation of a long-term home-based exercise training programme using minimal equipment in COPD patients: A multi-centre randomised controlled trial

Abstract Background Although exercise training is an important component of pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD), a majority of COPD patients fails to maintain training after PR. This study aimed to evaluate the effectiveness and implementation of a 12-months home-based, minimal equipment strength exercise programme. Methods Parallel arm, multicentre study across four Swiss PR clinics, random allocation of COPD patients (1:1 ratio) into intervention (IG) or control group (CG, usual care). Primary outcome was change in dyspnoea (Chronic Respiratory Questionnaire, CRQ) from baseline to 12-months, secondary outcomes change in exercise capacity (1-minute-sit-to-stand-test [1-min-STST], 6-minute-walk-test [6MWT]), health-related quality of life, exacerbations and symptoms. Main effectiveness analyses were based on the intention-to-treat approach and adjusted linear regression models were used. To assess the implementation outcomes dose, reach, fidelity, adherence, acceptability and appropriateness, we conducted interviews with patients, coaches and stakeholder and analysed reports, diaries and notes. Results 123 patients (IG: 61, CG: 62) were randomised, 61 females, mean (SD) age 66.8 (8.1) years, and 104 participants completed 12-months follow-up (IG: 53, CG: 51). Of 53 IG participants, 37 (70%) conducted the training until study end. We found no difference in change of CRQ dyspnoea over 12 months (adjusted mean difference 0.28, 95% CI -0.23-0.80, p = 0.27). We found moderate evidence for a difference in 1-min-STST repetitions favouring the IG (adjusted mean difference 2.6 (95% CI 0.22-5.03, p = 0.033) but no evidence for an effect in other outcomes. All involved groups perceived the strength-training exercises as appropriate, efficient for COPD patients and relevant to maintain improvements after PR. The patients' most important facilitators for long-term motivation were self-perceived improvement in strength, supervision by a coach and integration of the training in daily routine. Based on these insights, we redesigned and reworded the training material and introduced three new exercises. Conclusions The exercise program had no effect on dyspnoea but improved 1-min-STST performance and patient-perceived fitness. The results from the insights of the involved persons enabled us to optimize the program for sustainable further use in clinical and other settings and inform the future design of patient-centred home-based exercise programs in COPD.


Background
A widespread dissemination of effective evidence-based physical activity (PA) interventions is needed whether a greater proportion of the population, who could potentially benefit from it, wants to be reached (Finch et al., 2016). 'Sigue la Huella' (Follow the Footprint), is one of the few effective evidence-informed PA school-based interventions conducted on adolescents in Europe, with the support of the family and the community (Murillo et al., 2014). The main aim of this study is to describe and analyze the process of dissemination of this intervention program. Methods The 'Sigue la Huella' was implemented at one secondary school situated in Jaca/Huesca (Spain). The Replicating Effective Programs (REP) framework was used, because provides a roadmap for disseminating effective interventions (Kilbourne et al., 2007). The intervention was delivered through workshops, ongoing technical assistance to the teachers, and the distribution of an instructional guide among the teachers the school staff. A quasi-experimental design was adopted to examine the effect of 'Sigue la Huella' after its dissemination process. PA was assessed using accelerometers at baseline and after the intervention of 14 weeks. In addition, we evaluated the dissemination process using the PRACTIS guide (Koorts et al., 2018).

Results
From an initial evaluation of the dissemination process, several key learnings emerged: To identify strategies for effective stakeholders engagement; To overcome some barriers such as the excess workload of the teachers in charge of disseminating the intervention program; For better measures to determine the success of dissemination approaches (e.g., reliable and valid indicators of organizational and policy change).

Conclusions
This study provides a comprehensive overview of the dissemination process of an effective school-based program identifying contextual barriers and facilitators that influence program implementation in new contexts and the direction of Background Primary school physical education (PE) is critical for the development of skills that are essential for lifelong participation in physical activity (PA). Despite this, PE provision in Irish schools is inconsistent, while just 17% of Irish children currently achieve the recommended 60 minutes of daily PA. PE exposes children to regular, developmentally appropriate PA and teachers are essential in ensuring high quality PE is provided. This study aims to examine the perceptions and practises related to PE amongst Irish primary school teachers. Methods A survey was developed and validated using a modified Delphi technique and included 57 questions to examine Irish primary school teachers current teaching practices and supports needed to enhance their PE provision. A link to the survey was emailed to all Irish primary schools and shared on social media. SPSS version 27 was used for data analysis.

Results
Of the 473 respondents, 84.4% were female, 15.2% male and 0.4% didn't say (median age=34 (IQR=12)). Respondents indicated PE is timetabled (90.7%) and taught weekly (97%) in most schools. Time allocated for PE is used for other subjects in 35.9% of cases. Respectively, 40.8% and 52.4% of respondents indicated they never plan for or reflect on their teaching of PE. Just 57.1% of respondents indicated sufficient facilities, while 46.3% believe their equipment is insufficient. Approximately half (45.5%) have undertaken continuous professional development, citing a lack of courses offered, time and other priorities as barriers to undertaking additional training. Teachers cited their own lack of competence and confidence to teach PE as reasons why they would welcome engagement from a specialist PE teacher for certain strands (32.3%) or as a general support in PE (24.1%).

Conclusion
Although the vast majority of primary school teachers deliver PE on a weekly basis, these findings suggest teachers require additional supports to assist in their provision of PE. Novel approaches, such as the engagement of specialist PE teachers to support delivery in primary schools, are required to PE for Irish youths.
Abstract citation ID: ckac095.030 P02-11 Effectiveness and implementation of a longterm home-based exercise training programme using minimal equipment in COPD patients: A multi-centre randomised controlled trial

Background
Although exercise training is an important component of pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD), a majority of COPD patients fails to maintain training after PR. This study aimed to evaluate the effectiveness and implementation of a 12-months home-based, minimal equipment strength exercise programme. Methods Parallel arm, multicentre study across four Swiss PR clinics, random allocation of COPD patients (1:1 ratio) into intervention (IG) or control group (CG, usual care). Primary outcome was change in dyspnoea (Chronic Respiratory Questionnaire, CRQ) from baseline to 12-months, secondary outcomes change in exercise capacity (1-minute-sit-to-stand-test [1-min-STST], 6-minute-walk-test [6MWT]), health-related quality of life, exacerbations and symptoms. Main effectiveness analyses were based on the intention-to-treat approach and adjusted linear regression models were used. To assess the implementation outcomes dose, reach, fidelity, adherence, acceptability and appropriateness, we conducted interviews with patients, coaches and stakeholder and analysed reports, diaries and notes. Results 123 patients (IG: 61, CG: 62) were randomised, 61 females, mean (SD) age 66.8 (8.1) years, and 104 participants completed 12-months follow-up (IG: 53, CG: 51). Of 53 IG participants, 37 (70%) conducted the training until study end. We found no difference in change of CRQ dyspnoea over 12 months (adjusted mean difference 0.28, 95% CI -0.23-0.80, p = 0.27). We found moderate evidence for a difference in 1min-STST repetitions favouring the IG (adjusted mean difference 2.6 (95% CI 0.22-5.03, p = 0.033) but no evidence for an effect in other outcomes. All involved groups perceived the strength-training exercises as appropriate, efficient for COPD patients and relevant to maintain improvements after PR. The patients' most important facilitators for long-term motivation were selfperceived improvement in strength, supervision by a coach and integration of the training in daily routine. Based on these insights, we redesigned and reworded the training material and introduced three new exercises.

Conclusions
The exercise program had no effect on dyspnoea but improved 1-min-STST performance and patient-perceived fitness. The results from the insights of the involved persons enabled us to optimize the program for sustainable further use in clinical and other settings and inform the future design of patient-centred home-based exercise programs in COPD. Keywords: COPD, home-based exercise training, randomised controlled trial, effectiveness, implementation evaluation Abstract citation ID: ckac095.031 P02-12 The implementation cost of a walking football exercise program for patients with type 2 diabetes: a case study of SWEET-Football (Portugal) Background Economic analysis of health interventions is essential to the development and implementation of sustainable health policies, especially in noncommunicable diseases area. Type 2 diabetes (T2D) is one of the most relevant noncommunicable diseases globally. Regular physical activity is an established cornerstone of T2D control, with benefits in glycemic control, cardiovascular risk factors and quality of life. Thus, the current study aimed to assess the cost of a community-based physical activity intervention for patients with T2D.

Methods
We assessed the SWETT-Football program -a communitybased walking football exercise program for middle-aged and older male patients with T2D. The program was tested in Portugal through a scientific project (NCT03810846) funded by FIFA (FIFA Research Scholarship 2018). One season of this program consists of three sessions per week (60 minutes per session) during nine months (October to June). For the calculations, we considered a total of 40 patients (two groups of 20). We calculated the direct costs of one season for the host institution: 216 hours of renting a sports hall and hiring human resources (a football coach and a nurse); cardiac stress tests and sports insurance for the participants; sports equipment (balls, cones, vests); vital signs monitoring equipment (blood pressure, heart rate and capillary blood glucose); logistical equipment (disposable and non-disposable); and technical training. In addition, we considered an economic depreciation of five years for sports and electronic materials. Cost analysis dated January 2022.

Results
One season of this program for 40 patients with T2D was estimated to have a total implementation cost of 11,026.51E: 1,225.17E/month; 275.66E/patient; 51.05E/session; 30.63E/ patient/month; and 2.55E/patient/session. Conclusions A community-based walking football program for patients with T2D has an affordable cost and is feasible for large-scale implementation by local communities with the involvement of football clubs, municipalities and primary health care units, promoting physical activity and contributing to T2D control. Abstract citation ID: ckac095.033 P02-14 KaziBantu 'healthy schools for healthy communities' -A holistic approach to enhance health literacy and physical activity in primary schools from low-resourced settings in South Africa